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Are Bedrail Rails Safe to Use for Older Adults? Read this before you say No

As an occupational therapist, one of the most common questions I get asked is which bed rail to buy.  This has become an even more frequent question since the news broke of 3 asphyxiation cases in older adults that prompted a bed rail recall in December 2021.

But don’t throw out the baby with the bathwater just yet. Understanding the reasons why these particular bars were recalled will help you decide if this solution is right for you.

Personally, I love the function of bed rails. It is one of the first things I recommend when doing Home Safety assessments.

Why I love bed rails

They are one of the best solutions to stop an older adult from rolling out of bed and to provide support to steady yourself as your blood pressure normalizes before you get up to go to the bathroom in the middle of the night.

Bedrails are reasonably inexpensive, easy to install and often come with a storage pocket for easy access to the remote control or reading glasses. Some can be broken down for travel during the holidays.

They come in lots of different sizes and variations to address specific issues. I use them a lot for clients who need extra help getting in bed after hip, knee, spine surgeries.

Older patients with limited core strength benefit from having something to resist against to compensate for those weaknesses.

Many people with Parkinson’s Disease suffer from REM disorder which makes them act out their dreams and fall out of bed. A barrier can stop them from ending up in the space between the bed and nightstand.

If budget is a consideration, sometime considering 2nd hand children’s bedrails can be beneficial if the person using it is small and won’t be putting a lot of pressure on it.

User error and marketing shortcomings

Marketing departments likely do not employ staff with medical backgrounds.  This can lead to mistakes made by the design team who are unfamiliar with the correct use of the home safety device they are marketing.

How many people do you think read the fine print instructions when setting up medical equipment?  Not many would be my guess.

We are all busy and just trying to solve a problem. The false assumption is that it must be safe if we just follow the picture on the box.

Small details like this can make a big impact on function and potentially lead to companies facing liability if someone is seriously injured due to their oversight.

A great product wrapped in a marketing nightmare

This bed rail is one of my favorites but the image on the box is so poorly executed.

When I filter this picture through my clinical brain, the Xs are where I see red flags. Read on for an explanation of the issues.

Location of the bedrail

It’s very confusing to patients when they see these images of bedrails in the middle of the bed. I get puzzled phone calls all the time about how are they supposed to get their legs in the bed if they install it according to the picture.

My answer is always to ignore the picture and install it at the head of the bed so the legs can swing in.  

The location of the bed rail legs are definitely a tripping hazard in this location but if you install it at the head of bed, the legs are now tucked away and less of a trip hazard.

If the risk of tripping is significant, such as with patients with low vision, bedrails are available no feet on the floor.

However, when patients are weak in the core, they tend to push the bedrail outwards and the rail will slide out from btwn the mattress and box spring. This creates a gap where someone could roll off the bed and be stuck between the rail and mattress.  This is the likely mechanism for the incidents.

One way to combat this is that some manufactures include straps to attach around the box spring to prevent motion. I always recommend this for safety and to decrease the hassle factor.

One consideration is when you need to attach a bedrail to an adjustable bed where the head raises. You’ll want to lift the mattress up and measure the distance between the supports underneath to make sure the bedrail you order will slide into that space.

High pile Rug

High pile rugs the perfect place to catch your toe or walker and fall when getting back into bed after going the bathroom at night. If you are not attached to the rug, ditch it.

If you liked the rug because you get cold feet, buy a warm pair of fuzzy Croc slippers or buy pilates socks with grips on the bottom to wear to bed. Amazon also sells tall white socks with little grips on them too.

Whatever you do, don’t wear the awful socks you get from the hospital that just flop about. “One size fits none” is the more accurate and it’s a significant fall risk.

Sharp corner night table

There is much less risk of skin tears when getting in/out of the bed if the furniture has rounder edges. This is especially important if you are on blood thinners or have suffered from a stroke where you may pay less attention to that side of your body.

Patients who take steroids to manage diseases develop such thin skin that is so fragile that sometimes even bumping it on a hard surface can cause it to break open. 

Lastly, if you do fall and you are unlucky enough to hit your head on the sharp corner, this could result in a serious head injury or even death.

Cluttered night table

Combating clutter is most effective and most inexpensive way to decrease the risk of falls.

Sudden falls leading to significant injury are frequently due to movements that put you unexpectedly off balance.  

For example, it’s possible that the toe that gets caught on the rug does not cause a fall but that little trip on the rug creates enough vibration that it knocks the top-heavy lamp or unbalanced vase off balance.

You instinctively lurch forwards to stop the flowers and water from spilling onto the rug and lose your balance in the effort.

The best case scenario is that you and everything on that table will crash to the floor, waking your spouse out of a dead sleep and everyone will be wide awake and cleaning up a giant mess at 3am.

The worst case scenario is that you will be calling rescue at 3am and scrambling to gather clothes and medications to bring to the hospital. Many a broken hip have a backstory like this one.

When you are out shopping, make sure you buy one that is big enough for adequate storage of a phone, a book, a water bottle and a light source if there is no place to install one on the wall.

If you buy a lamp, choose on that has a big base so it can’t topple over. Ideally, you can plug it into a smart plug and be completely voice activated to decrease the risk of falls when walking over in the dark to turn on the light.

What to do if you need a bed rail

First, always install it at the head of the bed. If you need something longer, you can buy a longer bed rails but always start at the head.

Second, make sure it is attached to the box spring so it can’t be pushed away. If the style you like doesn’t come with a strap that goes around the boxspring, you can secure it with rope or go to an auto supply store to buy heavy duty canvas tie downs that are long enough to go around the mattress.

Lastly, assess the severity of the situation. Bedrails are meant for light support and tactile cueing. If someone is really weak and can’t get themselves up without a lot of help, bedrails are likely not the answer. A hospital bed will be able to provide the kind of support needed with a built in frame and automatic functions that can compensate for weakness.

How to sort through the choices on Amazon

Different features have different benefits for different people. The key is knowing which is which so that you aren’t making 10 trips to UPS to return yet ANOTHER rail that just doesn’t work!

Think about what problem you are trying to solve.

If you’re just trying to keep them from rolling off the bed and they are likely to wake up as soon as they feel the resistance, a light duty bed rail will work.

If they are needing help to go sit to stand when getting out of bed, you’ll need something stronger that can sustain the weight of their body.

If they already have an automatic bed but need the hand support, it might be more important for you to check the measurements between the bed to help you determine which rails are available for your use.

What to do if you still need help

Evolving Homes provides virtual consultations to address all the potential issues needed to Age-in-Place successfully.

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